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1、Nursing is an art which is supported by science and practiced for the enhancement of human health护理是一门以提高人们的健康为目的的科学与实践结合的艺术Mr. Wu, I am your nurse for today. My name is Miss Lu. Your doctor has ordered a special medicine to treat the infection in your gall bladder that must be given directly into y
2、our vein. This will require putting a needle in the vein of your hand or arm. Have you ever had an IV before?吴先生，今天我是你的护士， 我叫刘小姐，你的医生开了一种药来控制你胆囊里的炎症，这种药需要直接进入你的静脉，因而我要在你的手上或前臂的静脉里放一根针，你以前打过吗？Yes, I had one several years ago when I was sick. It was a little painful, but if it will help me get well it
3、 is OK. Where will you put it?是的，几年前我生病时曾打过一次，有点痛，但如果能帮我好起来，那没关系，你要打在哪里？I will try to put it here on your left hand, but if that doesnt work I may need to put it in your arm further up.我会先试一下你的左手，但如果不行，就打在你的手臂上。Mr. Wu, I am Xiao Lin and I will be your nurse today. I know you just got back from surge
4、ry about an hour ago and your surgeon removed your gall bladder this morning. How are you feeling now?吴先生，叫小林，我是你今天的责任护士，我知道1小时前，你刚手术回来，今天早上你的医生把你的胆囊切除了，现在你觉得如何？I am a little sleepy and I hurt some in my abdomen right here. It is also a little painful if I take a deep breath.我有点想睡，腹部这里有点痛，深呼吸时也有点痛。Y
5、es it is always a little painful right after surgery but we will help you and your doctors have given you medicine for pain. This will make it easier to breathe deeply and get out of bed. I will help you sit up and take a deep breath right now. This may be a little painful but it will help prevent y
6、our getting pneumonia.是的，刚手术后总是会有点痛，但我们可以帮你，医生已为你开了一些止痛药，这会使你更容易深呼吸和起床，现在我要帮你坐起来做深呼吸，这可能会有些痛，但能帮助你防止肺炎的发生。 Earned, not assumed 赢得而不是假定的 Built on honest direct communication 基于诚实的直接交流 Equal rights of expression of views同等表达观点的权力 Does not allow intimidation, denigration and abuse of all kinds 不允许有威逼,
7、破坏名声,滥用权利 Assumes every human being has value and their own unique contribution 假定每个人都是有价值的，有他们独特的贡献Dr. Zhong, your staff ordered TPN for Mr. Wu, bed three, room 6, Tomorrow, patient is going to have the surgery,the physician suggest to put a central line, but our APN nurse feel it is the difficulty
8、 case for her to do this procedure because the patients short. Could one of your staff help us?钟医生，外科医生为吴先生，6号房间3号病床，开了TPN医嘱，病人后天要手术，医生说今天就要给病人深静脉留置进行TPN治疗，但我的护士觉得这一病人头颈短，在病区内做深静脉置管较危险，因而，你能否请你的麻醉师帮我们一下Thank you for mentioning the problem. I will ask our anesthesiologist to deal with the issue. Plea
9、se ask your nurse staff send the patient to the operating room in a few minutes.谢谢你提出这个问题，我会叫我的麻醉师帮助你们，请马上把病人送到手术室。Dr.Li, Your staff ordered intravenous antibiotics for Mr.Wu,bed three, room 6, for his cholecystitis, but our staff has not been able to start an IV.Actually we tried several times and
10、we were thinking a central line might be preferable in this patient anyway. Our advanced practice nurse who usually would put in a central line is away this week with the Gobi March. Could one of your staff help us?护士长护士长: 李医师,你医生为6号房间3号床病人开了静脉内抗菌素治疗，但我的员工无法开通静脉，事实上我们已试了几次。但我想对这个病人来说做深静脉置管更好，我们的临床高级
11、护士通常能置深静脉，但这次她不在医院，你们的医生能帮我们一下吗？I heard about the problem. Could one of your staff help us?李医生李医生: 我已听到了这个问题，我们能到办公室去谈一下吗？Yes, of course护士长护士长:当然可以Dr. Li speaking: I just came from the patients room and the family is quite unhappy with the new nurse who could not start the IV. Do you know why none o
12、f our more experienced nurses were available to able to help here after her first attempt when the family began complaining?李医师：我刚从病房里出来，对我们新护士不能开通静脉，家属很不开心，你知道为什么新护士一针不成功时，在家属开始抱怨前，没有老护士去帮那位新护士。Nurse Manager: Actually, I was there and did try to help but the patients veins are very small and we jus
13、t could do it. The family did say they were upset while I was there.护士长：事实上，我在那儿，也尝试过尽可能的开通静脉，但病人的静脉实在太细，我们无法开通，我在那里的时候，家属已经不高兴了。Doctor: Sounds like I may not have gotten the story straight. Let me see if I can get one of the anesthesiologist to start a central line 李医师: 听起来我得到的信息有所偏差，我看我能否叫我们的一名医生来
14、做深静脉穿刺Xiao Lin, Mrs. Wu in bed 4, room 5 should have gotten her insulin at 3 pm, what happened?小李：5号房间4号床的吴女士在3PM应当注射胰岛素了，为什么没打？出了什么事？Dr. Li, the endocrinologist was here just before three pm and recommended we change her control to oral medicine only. Here is their note on the chart. The diabetic e
15、ducation nurse was here too and she feels it is probably unrealistic to expect this family to give insulin at home. Actually here blood sugars have not been very high except twice when they were drawn from the dame arm she was getting her IV which had glucose in it小李：三点之前内分泌科医生李医生在这里，建议我们只用口服降糖药，这是病
16、人病历上的记录，刚才我们的糖尿病APN护士也在这里，她觉得病人回家后让病人家属注射胰岛素不现实，事实上，她的血糖除了二次因为手臂上挂葡萄糖而抽得的血结果血糖比较高外，其他几次都不太高， 。 Sure enough . Hmmm, I will need to call Dr .Li and get this cleared up .I told the family she would need insulin. I would appreciate it if the nurse would call me if there is an apparent 好，我会打电话给李医师澄清这一事情，
17、我已告诉病人家属病人需要打胰岛素，当医生对病人的医嘱分歧较大时，你们护士应当打电话通知我，我将非常感激。 I agree that would have been helpful. We will keep that in mind 我同意这样会更有益一些。我们会记住的Shared commitment for implementation of decision分享努力实施决策Assumes both parties to the communication have shared in the planning假定双方在计划时分享交流Expecting people in authorit
18、y to have all the answers is irresponsible期望权威人有所有的答案是不负责任Expecting to have all the answers yourself is demagoguery期望你自己有所有的答案是非理性的On the Level communication does not allow, “The committee met and I decided”平等的交流不允许“委员会开会，我决定”On the Level communication does not allow, “It is a bad plan, but I didnt
19、want to say anything”“平等交流不允许”那时一个坏计划，但我不想说任何事Failure as well as success is almost always collective, not singular失败成功几乎总是集体的，而非个体的。We need to stop blaming the people “down there” for lack of motivation and the people “up there” for the abuse of power and get on with building a workplace based on sh
20、ared responsibility我们需要停止埋怨那些 在我们 “下面 ” 人们缺乏工作主动性和那些在我们“上面”高高在上乱用权力，开始以分享责任为基础来建设我们的工作环境。Nurse unit manager: Xiao Lin, would you get Mr. Wu up today and be sure he breathes deeply and coughs? 病房护士长：小林，你能否叫吴先生起床，让他做深呼吸和深咳嗽吗？Xiao Lin: But Mr. Wu is not my patient today. 小林：但是吴先生今天不是我的病人Unit manager: I
21、 know he isnt, but three of your patients are going home and Mr. Wus nurse has more than she can handle today, so I thought you could help with Mr. Wu. 病房护士长：我知道他不是，但是你的三个病人就要出院了，吴先生的护士今天忙不过来，因此，我想你可以帮帮吴先生。Xiao Lin, this means you have to make a nutritional assessment on every patient you admit and
22、if there is a problem place your report form on the front of the chart before you finish your shift. 小林，这意味着对每一位入院病人要做营养评估，如果有问题，在你下班前就把报告放在病历的前页。 。I can see this is important and I will do my best to do it but I think the doctors should be the one to do this, we are already too busy. 我能理解这很重要，我会尽我最
23、大的努力做的，但我想这应当是医生做的事，我们已经太忙了Yes, the nurses are often short handed, but the doctors are also busy and we have agreed to help in this way. Since this is a new requirement I will try to remind all of the nurses and help you as much as I can.是的，我的护士总是那么忙，但是医生也很忙，我们已经同意这样做了，由于这是一个新要求，我会努力提醒所有的护士，我会尽我所能帮你
24、。Communication is focused and purposeful 交流应当是集中,有目的的Oriented to a specific result围绕特定的结果 Purpose not so rigid as to prevent change if new information indicates the need目的不是僵硬一成不变的Final solution to question or problem not always necessary, merely a better understanding of the issues could be an adeq
25、uate purpose对问题的最终解决或答案并不总是需要的，只是对事物的更好理解也是一种恰当的目的。Nursing director: Xiao Lin, as you know, your patient, Mr. Wu was taken to ICU during the night. This was necessary because he was having trouble breathing and required a respirator. The nursing record shows you were aware of and recorded a rapid re
26、spiratory rate at the end of your shift but there is no record you informed either the doctor or the nurse manager. Can you tell me what happened from your point of view? 护理部主任：小林，你知道，你的病人吴先生在晚上被转到ICU，因为病人有呼吸困难，要用呼吸机，护理记录单上显示下班前你意识到这种变化,并记录病人呼吸频率很快，但没有记录你通知了医生或护士长，从你的角度你能告诉我发生什么。Xiao Lin: That is co
27、rrect. I did notice his respiratory rate had gone up to 24 per minute so I wrote it down. I was going to call the resident but then I got a phone call from my friend and I forgot to call or tell anyone before I left. But other nurses knew he was breathing fast too. 小林：是这样的，我注意到病人的呼吸上升到24次/分，因此我就把它记录
28、下来了，我正要传呼或告诉其他人的时候，我接了一个朋友来的电话,当我下班前,我忘记叫医生或其他人了,但其他护士也应当知道病人呼吸很快。Nursing director: Xiao Lin, you know it was your responsibility to pass on this information. Is it not true you and the nurse manager have had two similar discussions in the past three months?护理部主任：小林，你知道这是你的责任将这些信息告诉别人，在过去三个月里，类似的问题护
29、士长曾与你讨论过 Xiao Lin: Yes, and I am really very sorry.小林：是的，我很抱歉。 Nursing Director: I understand we are having a problem with the new policy on nutritional assessment, is that why you wanted to see me? 护理部主任：我了解到对营养评估新制度实施方面有些问题，这是你想见我的原因吗？Nurse Manager: I am not sure whether it is a compliance problem
30、 or a lack of staffing. The dieticians say they are willing to come and consult but the reality is they are not coming to consult on all the patients with nutritional problems. And so far I havent figured out exactly why. The nurses are putting the assessment report on the front of the chart when th
31、ere is a problem, but the doctors rarely ask for the dietary consult. They just write they have taken care of it or it isnt needed and sometimes they forget to deal with it altogether unless I push them. 护士长：我不知道这是遵守制度的问题，还是人力不足的问题，营养师说他们愿意来会诊，但事实上他们没有来会诊所有营养问题的病人，目前我还不知道究竟为什么，护士把有营养问题的筛选评估单放在医生病历的首
32、页，但医生很少请营养师会诊，他只是说已处理了或者不需要，有时医生忘记去处理它，除非我催他们。 Director: Sounds to me like we need more information. Why dont we ask for a meeting with the director for graduate medical education, he is the one most familiar with the residents and most of these orders for dietary consultation would be written by th
33、e residents. 护理部主任：听起来我们需要更多的信息，为什么你不问一下医务科科长在行政会议上强调一下，让医生今后更关注这一问题。 Guide lines and goals, not policy 是指导和目标，而不是制度 Best done one on one, face to face 最好一对一、面对面的做 Anticipate need for change 预测改变的需要 Anticipate a positive experience 预测积极的体验 Anticipate improvement in skill 预测技能上的改进 Anticipate gratification 预测满意